Dear Addy: COBRA and the ACA
It used to be when you left or lost your job you could get COBRA coverage until you found a new job. What is happening to COBRA with ACA implementation? What happens now if I lose my job and need health insurance?
Daniel, Hemophilia Patient
If you lose your job, you have two choices: you can (1) sign up for a Marketplace plan or (2) go on COBRA. Under the ACA (Affordable Care Act), losing a job is considered a “qualifying life event.” A qualifying event is one that opens the door for you to enroll in a Marketplace plan outside of the annual enrollment period. Such events included marriage or divorced, change in income, pregnancy, or adoption of a child, for example. (You can find a full list here.)
Consider the following when deciding which path, Marketplace plan or COBRA, to take to assure you have health insurance.
- Option 1: If you lose your job or leave your job for any reason, you can buy health insurance from the Marketplace. You can access the Marketplace in your state online at healthcare.gov. If you don’t have internet access, you can call 800-318-2596. Provide the requested information to find a plan or to see if you qualify for some form of assistance like Medicare or Medicaid. By applying, you will find out if you can qualify for lower costs on your monthly premiums and lower out-of-pocket costs for private insurance plans and/or for free or low-cost coverage through Medicaid or the Children’s Health Insurance Program (CHIP).
- Option 2: If you lose your job or leave your job for any reason, you may be able to keep the same insurance you had at your job through COBRA continuation coverage. COBRA (Consolidated Omnibus Budget Reconciliation Act) is a federal law that may allow you to pay to keep you and your family on your employee health insurance for a limited time (usually 18 months) after your employment ends or you otherwise lose coverage. The COBRA option can take a bite out of your wallet, though. First, if you choose the COBRA option, you will have to pay the full monthly premium for your health insurance (your employer probably paid a portion of this when you were employed) plus a small administrative fee. Also, if you choose COBRA you will not be able to take advantage of any subsidies or reduce out-of-pocket costs for which you may qualify using the Marketplace.
Ultimately, the choice is yours as to which option you choose, but choose wisely. If your COBRA coverage expires, you still have the option to choose a Marketplace plan. Remember, if you are without health insurance for less than three months, then you will not have to pay a penalty, but going without health insurance is not the best option (especially when you or a family member is treating a bleeding disorder)!
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HFA frequently receives questions from the bleeding disorders community related to advocacy issues. The questions often impact the entire community. In an effort to reach the largest audience possible with our responses to these widely applicable questions, HFA developed “Dear Addy.” Questions submitted to this column are edited in order to protect privacy and should be considered educational only, not individual guidance.
Assisting and Advocating for the Bleeding Disorders Community